A global study covering more than 20 years and about 207,000 people showed that two factors have the greatest influence on the life expectancy of people with HIV – age and CD4 cell count. Experts have found that patients on antiretroviral therapy (ART) with high CD4 counts have a life expectancy that is almost the same as that of the general population. Work results published in The Lancet HIV.
The life expectancy of people with HIV has increased dramatically since the introduction of effective ART. In a new study, an international team of scientists assessed whether long-term HIV infection can shorten life expectancy despite successful treatment. The experts analyzed 20 cohort studies that were conducted in high-income countries (Europe and North America). A total of 206,890 people living with HIV were included in the analysis. Participants were divided into 2 groups: those who started treatment between 1996 and 2014 and those who started therapy between 2015 and 2019.
Research results
After accounting for all differences in risk factors, CD4 count was considered the most important: the higher the number of CD4 cells, the lower the risk of death.
People with a CD4 count below 50 had an almost 5 times higher (372%) risk of death compared to those with a CD4 count above 500.
In people with a CD4 count of 200-349 cells, the risk is 2 times higher (by 92%).
Age also had a significant impact on life expectancy.
Participants aged 60-69 had a 3-fold higher risk of death (by 219%) compared to participants aged 30-39.
In patients older than 70 years – 8 times higher (666%).
Women had a 23% lower risk of death than men.
- Transmission route
Participants who acquired HIV through injecting drug use had a 2.5 times higher (148%) risk of death than men who acquired HIV through sex with men (MSM). According to experts, this may be due to socio-demographic factors and health risks associated with drug use.
People who got HIV during heterosexual intercourse had a 24% higher risk of death than MSM.
- Start of treatment
The period when patients started antiretroviral therapy affected the risk of death to a lesser extent than other factors.
1996-1999 – the risk is 30% higher compared to those who started treatment in 2015-2019.
2000-2004 – 21% higher compared to those who started treatment in 2005-2009.
2005-2009 – 18% higher compared to 2010-2014.
- Other risk factors
Viral load above 50 copies – 30% higher chance of death.
Hepatitis C – 38% higher.
Advanced stage of HIV (AIDS) – by 60%.
Interestingly, a factor such as previous use of ARV therapy with increased side effects did not affect life expectancy as significantly as the researchers expected (18% higher risk).
Life expectancy calculation
People who started treatment before 2015 had an average life expectancy 76 and 75 years old in women and men, respectively. In comparison, for the general population, 86 years old and 81 years old. However, depending on risk factors, these indicators could vary significantly.
Conclusion
The authors of the study emphasize the importance of early initiation of ART and high adherence.
2023-05-23 09:41:44
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